Concussions—Myths and Facts

By David Dubin, M.D.

Our appreciation of concussions has come quite a long way in recent years. Some of the old “truisms” associated with concussions are now understood to be misleading and at times are outright false. Below are some of the common concussion myths and the associated facts. Further research will enable us to take a closer look at what we now consider to be facts and reconsider the impact that concussions have on the brain.

In the late 80’s I trained as an emergency room physician. The first two myths in the list were “truisms” that I had been taught in medical school.

Myth: An injury to the head is not a concussion unless there is a loss of consciousness.

Fact: We now know that there is still damage to the brain even without loss of consciousness.

Loss of consciousness or “blackouts” occur in less than 10% of cases. Besides actually losing consciousness, signs and symptoms of a concussion include at least 3 of the following:

Headache and increased sensitivity to light and sound

Changes to reaction time, balance, and coordination

Changes in memory, concentration, judgment, speech, and sleep

Dizziness, fatigue, irritability, nausea or vomiting

Myth: If symptoms of head injury (most of which are subjective) persist for more than a month, then the problem is probably psychological.

Fact: We now know that persisting symptoms are both very common and very real.

Approximately 50% of patients with minor head injury have post-concussive symptoms at 1 month and 15% have symptoms at 1 year.

Myth: If the CT scan or MRI is normal, then there is no concussion.

Fact: A concussion is less of a “structural” injury than an imbalance of the needed chemicals or fuel that helps the brain function when someone is concussed.

This occurs at the cellular level, which is too small for a CT scan or MRI to pick it up.

Myth: The harder someone is hit, the worse the concussion, and the more likely that there will be residual problems.

Fact: It doesn’t necessarily take a big hit to produce a concussion.

Any contact that causes rapid head movement can cause a concussion. Several lower impacts over time might be more serious than a single big collision. Offensive linemen in football, who experience contact on almost every play, may be more at risk for permanent brain damage compared to a wide receiver who absorbs a single hard hit once or twice a game. Also, most instances of post concussion syndrome (PCS) occur with mild traumatic brain injury. Overall, the severity of injury does not correlate well with the risk of PCS.

Myth: Men and women have equal amounts of concussions

Fact: Men experience minor head injury more frequently than women, but the incidence of post concussive syndrome is greater in females than in males.

Symptoms may vary by gender. Men with concussions experience more physiological issues such as balance problems while women experience more psychosocial issues such as fatigue or low energy. 50% of those who experience minor head injury are aged 15-34 years. However, post concussive syndrome has no predilection for any specific age group

Fact: Helmets help prevent skull fractures and lacerations, not concussions.

Despite claims to the contrary, neither a specific brand nor higher costing helmets are associated with fewer concussions. Because the brain is floating inside the skull, many experts doubt whether it is possible to even develop a helmet that can prevent concussion. However, there is work being done on a helmet using new materials that actually disperse the impact and not just absorb it. This may result in fewer concussions.

Myth: It is life-threatening to let someone with a concussion fall asleep.

Fact: Rest and sleep are actually good for a concussion.

However, it is still suggested that athletes should not be left alone the first night and should be seen by a clinician who has experience with concussions the next day. Growing more and more lethargic (obtunded) occurs when a portion of the brain herniates through an opening in the skull. This is both very uncommon and a life threatening emergency requiring immediate surgery.

An athlete who has had one concussion is more likely to have another one than an athlete who hasn’t been concussed. Once an athlete has experienced one concussion, the threshold for sustaining another concussion can be diminished. Also, if a player sustains another blow before he or she is fully recovered, the resultant symptoms can be worsened. There is also a rare phenomenon called Second Impact Syndrome that can cause impaired brain blood flow or even death if an athlete suffers another trauma before fully recovering.

Myth: Concussions are rare events.

Fact: Concussions are much more common than we realized in the past.

If you suspect a student-athlete of having a concussion, assume it’s a concussion. If an athlete describes having a headache or dizziness, shows signs of balance problems, or difficulty remembering, assume that player is concussed and have him or her evaluated.

Myth: Most concussions occur during game time between opposing teams.

Fact: Research has shown that limiting full-contact tackling during high school football practices can dramatically reduce the number of concussions.

One study showed that the rate of sports-related concussions that occurred during high school football practice was more than twice as high than those that occurred during game time.

Myth: Once the symptoms of a concussion disappear, the brain is healed.

Fact: The brain is still injured from a concussion for months after the symptoms resolve.

After a mild concussion, special brain scans show abnormalities in the brain up to four months later, when symptoms from the concussion have mostly dissipated. However, standard brain scans such as CT or MRI do not pick up on these subtle changes in the brain. Unfortunately this often promotes the common misperception that any persistent symptoms are psychological.